Healthcare Provider Details

I. General information

NPI: 1710638564
Provider Name (Legal Business Name): LYSSA BAROCHIN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 JOHNS CREEK PKWY STE 100
SUWANEE GA
30024-5683
US

IV. Provider business mailing address

3199 FOXCROFT RD APT 104
MIRAMAR FL
33025-4171
US

V. Phone/Fax

Practice location:
  • Phone: 404-847-9999
  • Fax:
Mailing address:
  • Phone: 678-683-4466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT38070
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: